Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health (...) care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly. (shrink)

While we agree that the frame problem, as initially stated by McCarthy and Hayes (1969), is a problem that arises because of the use of representations, we do not accept the anti-representationalist position that the way around the problem is to eliminate representations. We believe that internal representations of the external world are a necessary, perhaps even a defining feature, of higher cognition. We explore the notion of dynamically created context-dependent representations that emerge from a continual interaction between working memory, (...) external input, and long-term memory. We claim that only this kind of representation, necessary for higher cognitive abilities such as counterfactualization, will allow the combinatorial explosion inherent in the frame problem to be avoided. (shrink)

Ayudha Puja, a South Indian festival translated as “worship of the machines,” is a dramatic example of how religion and science intertwine in political life. Across South India, but especially in the state of Karnataka, scientists and engineers celebrate the festival in offices, laboratories, and workshops by attending a puja led by a priest. Although the festival is noteworthy in many ways, one of its most immediate valences is political. In this article, we argue that Ayudha Puja normalizes Brahminical Hinduism (...) within scientific culture through the inclusion of non-Hindus and through scientists' description of the festival as “cultural” rather than “religious.”. (shrink)

Interest in the computational aspects of modeling has been steadily growing in philosophy of science. This paper aims to advance the discussion by articulating the way in which modeling and computational errors are related and by explaining the significance of error management strategies for the rational reconstruction of scientific practice. To this end, we first characterize the role and nature of modeling error in relation to a recipe for model construction known as Euler’s recipe. We then describe a general model (...) that allows us to assess the quality of numerical solutions in terms of measures of computational errors that are completely interpretable in terms of modeling error. Finally, we emphasize that this type of error analysis involves forms of perturbation analysis that go beyond the basic model-theoretical and statistical/probabilistic tools typically used to characterize the scientific method; this demands that we revise and complement our reconstructive toolbox in a way that can affect our normative image of science. (shrink)

We commend Redish et al. for the progress they have made in bringing a measure of theoretical order to the processes that underlie drug addiction. However, incorporating information about situations in which drug users do not exhibit faulty decision-making into the theory would greatly enhance its generality and practical value. This commentary draws attention to the relevant human substance abuse literature.

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

A paediatric clinical trial conducted in a developing country is likely to encounter conditions or illnesses in participants unrelated to the study. Since local healthcare resources may be inadequate to meet these needs, research clinicians may face the dilemma of deciding when to provide ancillary care and to what extent. The authors propose a model for identifying ancillary care obligations that draws on assessments of urgency, the capacity of the local healthcare infrastructure and the capacity of the research infrastructure. The (...) model lends itself to a decision tree that can be adapted to the local context and resources so as to provide procedural guidance. This approach can help in planning and establishing organisational policies that govern the provision of ancillary care. (shrink)

Volume 20, Issue 5, June 2020, Page 40-42.

Determining whether a research risk meets or exceeds a regulatory standard of risk acceptability is difficult. Recently a framework called the systematic evaluation of research risks (SERR) has been proposed as a method of comparing research risks with predetermined standards of acceptability. SERR purports to offer a systematic and largely determinate (definite) way to compare risks and say whether a specific research risk falls below or above an acknowledged standard of acceptable risk. Here the authors review some philosophical problems with (...) this framework, which they take to be representative of determinate approaches to risk comparison, and conclude that it should not be used in a stand-alone or determinate fashion. Instead, the authors suggest that a deliberative approach may be a more viable candidate for future development. Such an approach could be informed by methods such as SERR without being rigidly bound to them. (shrink)

In this accessible and comprehensive work, Robert Solomon and Kathleen Higgins cover the entire history of philosophy--ancient, medieval, and modern, from cultures both East and West--in its broader historical and cultural contexts. Major philosophers and movements are discussed along with less well-known but interesting figures. The authors examine the early Greek, Indic, and Chinese philosophers and the mythological traditions that preceded them, as well as the great religious philosophies, including Christianity, Hinduism, Judaism, and Taoism. Easily understandable to students without (...) specialized knowledge of philosophy, A Short History of Philosophy demonstrates the relevance of philosophy to our times, illuminating the impact of the revolutions wrought by science, industry, colonialism, and sectarian warfare; the two world wars and the Holocaust; and the responses of philosophy in the schools of existentialism, postmodernism, feminism, and multiculturalism. In addition, the authors provide their own twists and interpretations of events, resulting in a broad view of the nature of philosophy as an intellectual discipline and its sometimes odd and dramatic consequences. (shrink)

The visibility of transhumanism in pop culture reveals its dramatic advance in twenty-first-century life. The more widespread the movement becomes, the more important it is to consider how transhumanism might be made relevant to global humanity. This article orients technological progress by drawing transhumanism into conversation with minjung theology from Korea. Minjung theology offers global tech culture—and its pursuit of technological salvation—an ethical foundation through attention to Han (an emotion specific to those who suffer from individual, sociopolitical, economic, and cultural (...) oppression but have been unable to express it adequately) and the lived reality of those who are often excluded from benefits of technological society. Working in the other direction, transhumanist perspectives on technology offer minjung theology an opportunity to expand its reach through the development of a transcendent theological perspective. (shrink)

Book reviewed in this article: The New Health Care For Profit: Doctors and Hospitals in a Competitive Environment. Edited by Bradford H. Gray The Healing Mission and the Business Ethic. By Robert M. Cunningham The Medical Industrial Complex. By Stanley Wohl.

For more than sixty years, surgeons have used bioethical strategies to promote patient self‐determination, many of these now collectively described as “informed consent.” Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will “fix” the problem. They omit critical information about the goals and downsides of surgery and present untenable options (...) as a matter of patient choice. We propose a novel framework called “better conversations.” Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment. (shrink)

Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation (CPR) in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in (...) the event of pneumonia. (shrink)

Sperm motility and respiration are tightly coupled processes, both activated by an increased intracellular pH (pHi). As the sperm pHi increases, the flagellar motor driving motility is activated, leading to ATP consumption. Energy for motility is provided by mitochondrial respiration; energy transport from sperm mitochondrion to tail involves distinct isozymes of creatine kinase that effect a phosphorylcreatine shuttle. The activation of sperm motility and respiration can be described as a linked series of biochemical reactions that form a cell behavioural pathway (...) analogous to the reaction sequences of intermediary metabolism. (shrink)

Sperm motility and respiration are tightly coupled processes, both activated by an increased intracellular pH (pHi). As the sperm pHi increases, the flagellar motor driving motility is activated, leading to ATP consumption. Energy for motility is provided by mitochondrial respiration; energy transport from sperm mitochondrion to tail involves distinct isozymes of creatine kinase that effect a phosphorylcreatine shuttle. The activation of sperm motility and respiration can be described as a linked series of biochemical reactions that form a cell behavioural pathway (...) analogous to the reaction sequences of intermediary metabolism. (shrink)

Olszewski and Goldkind's (2018) article on pediatric decision making in the clinical care setting is articulate and well written. The authors understand the challenges in ensuring that pediatric pa...

Background and aims: Recent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage. The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination and the Repeatable Battery for the Assessment of Neuropsychological Status for this purpose. Methods: Comparing 28 participants with ARBD and 30 alcohol-dependent participants without ARBD we calculated Area Under the Curve statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for (...) both tests. Results: High levels of screening accuracy were found for the total scores of both the ACE-III and RBANS at multiple cut-off points. Removing participants with a history of polysubstance from the samples improved the diagnostic capabilities of the RBANS substantially, while only minor improvements to the ACE-III’s accuracy were observed. Conclusions: Overall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods and more detailed neuropsychological testing before reaching diagnostic decisions. (shrink)

Clinicians cannot obtain valid consent to treatment because they cannot guess which treatment option will serve a particular patient's best interests. These guesses could be made more accurately if patients were paired with providers who share their deep values.

In celebration of the fortieth anniversary of the publication of Beauchamp and Childress’s Principles of Biomedical Ethics, a review is undertaken to compare the lists of principles in various bioethical theories to determine the extent to which the various lists can be reconciled. Included are the single principle theories of utilitarianism, libertarianism, Hippocratism, and the theories of Pellegrino, Engelhardt, The Belmont Report, Beauchamp and Childress, Ross, Veatch, and Gert. We find theories all offering lists of principles numbering from one to (...) ten. Many of the differences can be reconciled, but some critical differences remain. (shrink)

In its October 2001 issue, this journal published a series of articles questioning the Whole-Brain-based definition of death. Much of the concern focused on whether somatic integration - a commonly understood basis for the whole-brain death view - can survive the brain's death. The present article accepts that there are insurmountable problems with whole-brain death views, but challenges the assumption that loss of somatic integration is the proper basis for pronouncing death. It examines three major themes. First, it accepts the (...) claim of the "disaggregators" that some behaviors traditionally associated with death can be unbundled, but argues that other behaviors (including organ procurement) must continue to be associated. Second, it rejects the claims of the "somaticists," that the integration of the body is critical, arguing instead for equating death with the irreversible loss of "embodied consciousness," that is, the loss of integration of bodily and mental function. Third, it defends higher-brain views against the charge that they are necessarily "mentalist," that is, that they equate death with losing some mental function such as consciousness or personhood. It argues, instead, for the integration of bodily and mental function as the critical feature of human life and that its irreversible loss constitutes death. (shrink)

When a new, brain-based definition of death was proposed fifty years ago, no one realized that the issue would remain unresolved for so long. Recently, six new controversies have added to the debate: whether there is a right to refuse apnea testing, which set of criteria should be chosen to measure the death of the brain, how the problem of erroneous testing should be handled, whether any of the current criteria sets accurately measures the death of the brain, whether standard (...) criteria include measurements of all brain functions, and how minorities who reject whole-brain-based definitions should be accommodated. These controversies leave little hope of consensus on how to define death for social and public policy purposes. Rather, there is persistent disagreement among proponents of three major groups of definitions of death: whole-brain, cardiocirculatory or somatic, and higher-brain. Given the persistence and reasonableness of each of these groups of definitions, public policy should permit individuals and their valid surrogates to choose among them. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

_Minds, Brains, Computers_ serves as both an historical and interdisciplinary introduction to the foundations of cognitive science.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.3 (2003) 189-192 [Access article in PDF] Is There a Common Morality? Robert M. VeatchSenior EditorOne of the most exciting and important developments in recent ethical theory—especially bioethical theory—is the emergence of the concept of "common morality." Some of the most influential theories in bioethics have endorsed the notion using it as the starting point of their systems. This issue of the Journal (...) is devoted to these developments.The core idea of a common morality is that all humans—at least all morally serious humans—have a pretheoretical awareness of certain moral norms. The claim is that normal humans intuit or in some other way know that there is something wrong with things like lying or breaking promises or killing people. These purportedly universally shared insights can provide the raw data from which ethical theories are constructed. As such, they are perhaps analogous to the raw sense data that are relied on in the natural sciences to launch the construction of scientific theories and accounts of the nature of reality. Some common morality theorists suggest an analogy between the natural and the moral sciences.In the natural sciences there is a widely shared belief that some raw sensory data are perceived by all normal humans and provide the basis for the construction of various scientific theories. For example, it is widely believed that all normal humans looking at the top light on a traffic signal perceive something that in English is called "red." Of course, different cultures will use different language to describe this experience. They may parse the boundaries differently (varying on the exact borderline between red and orange), provide widely differing accounts of why the experience of "red" occurs, and eventually generate significantly different theoretical formulations to explain the experience of redness. Moreover, some individuals may look at that top light of the traffic signal and not see color at all. One generally, however, does not account for this by denying there is any objective, generally shared basis for the experience that produces a sensation of redness in normal people. One simply explains the experience of the one who fails to see color by positing a defect in perception, called "color-blindness."Some moral theorists suggest that something analogous happens when humans look at the moral scene. The claim is that all normal humans in all places and cultures "see" certain moral requiredness. They see that some behaviors are, in some sense, generally wrong; that other behaviors are generally right; that [End Page 189] some character traits are generally praiseworthy, others blameworthy. No sophisticated common morality theorist denies that, as with color-blindness, there may be occasional outliers who for one reason or another fail to intuit or perceive these simple, abstract moral norms. Certainly, people in different cultures will define the terms differently, will recognize different limits on the norms, and will construct different theories to account for their experience. The primitive idea that there is something generally wrong with killing other humans will be articulated very differently in different cultures—some referring to the "sacredness of life;" others to a duty not to kill, a right to life, or a prohibition on killing the innocent. Some may extend the insight to a duty to prolong living, others limit it merely to a prohibition of direct, active killing. Some may endorse more exceptions—for killing of unjust aggressors, for killing in just war, for killing in self-defense; others, such as pacifists, will be much more stingy in doling out exceptions. Certainly, people at different times and places will articulate the norms in different language and embed them in different theories. The basic claim of common morality theorists, however, is that there is some primitive, pretheoretical insight that is shared by all normal, morally serious persons.Recently, the notion of a common morality has served as a starting point for bioethical theories as diverse as Bernard Gert, Charles Culver, and Danner Clouser's Bioethics: A Return to Fundamentals (1997) and the latest edition of Tom Beauchamp and James Childress's Principles of Biomedical Ethics... (shrink)

"This reviewer had to be restrained from stopping people in the street to urge them to read it: They would learn something of the way science is done,...